March 17, 2023
Screening for Colorectal Cancer Saves Lives
In the spirit of Colorectal Cancer Awareness Month, Health Partners Plans (HPP) would like to remind you of recently expanded coverage for colorectal cancer screening. A number of screenings are covered for Medicare and Medicaid members as preventive services. Of cancers affecting both men and women, colorectal cancer is the second leading cancer killer in the U.S. However, the death rate has decreased over the past several decades, largely because of higher rates of screening.
Support colorectal cancer screening for your patients who are 40 to 75 years of age* by ordering one of the following screening tests:
- Fecal occult blood test (FOBT)
- FIT-DNA test (Cologuard)
- Flexible sigmoidoscopy
- CT Colonography
- Colonoscopy
People at increased risk for colorectal cancer include individuals with one or more of the following: one or more family members who have had colon or rectal cancer; certain types of polyps removed during colonoscopy; inflammatory bowel disease; and other risk factors might need colorectal screening before age 45. For people ages 76 through 85, the decision to be screened should be based on a person’s preferences, life expectancy, overall health and prior screening history.
NCQA updated the Measurement Year 2023 HEDIS guidelines and lowered the recommended age range for screening to ages 45 to 75. HPP has also implemented this change in the Medicare QCP program for Measurement Year 2023. All members ages 45 to 75 will be included in the denominator for this quality measure.
|
Activity |
Screening Recommendation |
Benefit Coverage |
|
Screening Colonoscopy |
Every 10 years |
HPP recently implemented colorectal screening as a preventive service for ages 40 and above; 1 unit per 2 calendar years no cost sharing |
|
Flexible Sigmoidoscopy |
Every 5 years |
Limit 1 unit per 4 calendar years; no cost sharing; ages 40 and above |
|
CT Colonography |
Every 5 years |
Not covered by Medicare as a preventive service. Prior authorization required for Medicare and Medicaid |
|
FOBT test |
Annually |
Limit 1 unit per calendar year; no cost sharing; ages 40 and above |
|
Cologuard |
Every 3 years |
Covered once every 3 years for Medicaid and Medicare members ages 40 and older; no cost sharing |
Home Testing
Non-invasive tests, such as FOBT or FIT-DNA test, are available; patients can be obtained from a test kit from Quest Lab location with a prescription. Additionally, HPP has partnered with vendors to mail kits to patients’ homes. Please speak to your Provider Relations Representative if you would like to learn more. You can also speak to your Quest representative about providing FOBT kits to patients at your office.
Member Rewards
HPP encourages all providers to remind patients that they can earn rewards for being proactive about preventive health screenings. Health Partners Medicare members are eligible to earn $25 in Medicare Wellness Rewards dollars if they complete one of the following colorectal cancer screenings: FOBT, Flexible Sigmoidoscopy or Colonoscopy, or FIT-DNA test.
Coding
The following colorectal services are covered for Medicare and Medicaid members as preventive services. When ordering one of these tests, please submit one of the following ICD-10 codes to signify screening and prevent cost sharing for members.
- Z12.11: Encounter for screening for malignant neoplasm of colon
- Z12.12: Encounter for screening for malignant neoplasm of rectum
If you have additional questions, please reach out to your Provider Relations Representative or contact our Provider Services Helpline at 1-888-991-9023, Monday – Friday, 9 a.m. – 5:30 p.m. Thank you for your support in providing the highest quality of care to our members.
* HEDIS guidelines are 45-70 years of age and is the range used when calculating HPP’s QCP incentive.